Background: This study was aimed to evaluate various clinical presentations of lacunar infarcts and correlating their localization with Radiological imaging Method: This Cross sectional study was conducted on 100 patients who admitted and attended at Dr. PSIMS & amp; RF which is a rural tertiary health care centre from July 2015 to November 2016. Patients presenting with various clinical Lacunar syndromes, were evaluated for etiopathogenesis, confirming the lesion localization with radiological imaging. Results: 100 patients were studied out of which 83 were hypertensives and 63 were smokers, 56 were diabetics. 63 patients were asymptomatic and 37 were symptomatic pure motor hemiparesis was seen 22 in symptomatic patients, most of them located in internal capsule region on radiological localization. Sensorimotor lacunar syndrome was seen in 10 patients, half of them having a thalamic lesion. 3 patients with ataxia hemiparesis had lesion at cortical and capsule ganglionic regions. 6 patients have lesions at multiple sites’ had lesions mostly located in cortical regions with different presentations. Conclusion: In our study, Hypertension and smoking were two most common risk factors for Lacunar infarct. Many of launar infarcts were asymptomatic. Pure motor hemiparesis is the most common type of lacunar syndrome with lesions commonly localized in internal capsule region.